Latest Comments by kayakrn7

kayakrn7 3,872 Views

Joined Dec 27, '06 - from 'Ohio'.
kayakrn7 is a Currently Program Liaison Joint and Spine Program, Program Liaison Fracture Program, DMAT OH-5 Member.
He has '10' year(s) of experience and specializes in 'Periop and Ortho'.
Posts: 8 (75% Liked)
Likes: 74

Frequently a close friend of mine, a young physician in Haiti, posts comments on a Web and Facebook page associated with a volunteer medical organization I co-founded to improve access to Child and Maternal Health Care in rural Haiti through the creation of sustainable Haitian run health care and of which he is the Medical Director. Here is a recent post he wrote after a weeklong rural medical mission sponsored by donations from our organization:

"You know what is important in humanitarian actions. I find it's great: One hour of time you give. One dollar you give. A charitable gesture you make. An act of generosity you make. One support you give. sometimes these are things that are not important to you. things that does not detract from you, your personality, your wealth. Can change or save the life of a person. someone you know or not. in your area or not. in your country or not. what a beautiful love .... we read in the Bible Jesus said in Matthew 25:40 'I tell you the truth, whatever you did for one of these brothers, you did for me.' Participate with us in this great love."

Now one may percieve this as poorly written, lacking the professionalism one would expect from a physician. However once you realize my young physician friend is a native Haitian; Haitian Kreole and French his languages of birth and choice- English a distant third, would your opinion be different? Each time he posts his comments, I always worry the message he is posting may be poorly understood or simply get lost in translation by our English speaking/reading audience. Even I find when I read his notes my American education sometimes blinds me to the actual message as I struggle to reconstruct the words into grammatically correct sentence structure, paragraph form, punctuation etc... blah, blah, blah! (My apologies to all my former amazing English teachers, current friends who are English teachers, and of course my amazing "word-smith" wife.)

But what I have learned is not to read with my brain. This time try reading the same message- but this time, read with your heart...so... breathe in... breathe out...and read on...

"You know what is important in humanitarian actions. I find it's great: One hour of time you give. One dollar you give. A charitable gesture you make. An act of generosity you make. One support you give. sometimes these are things that are not important to you. things that does not detract from you, your personality, your wealth. Can change or save the life of a person. someone you know or not. in your area or not. in your country or not. what a beautiful love .... we read in the Bible Jesus said in Matthew 25:40 'I tell you the truth, whatever you did for one of these brothers, you did for me.' Participate with us in this great love."

When I read it with my educated academic mind it was a very nice, sincere message...when I read it with my heart, it brought tears to my eyes...

Lesson learned "Always read with your heart"

Thank you my young physician friend- not only are you a great healer and a great man, but also a great teacher...

Recently, while rounding on one of my patients, I noticed she seemed quieter than usual, so I sat down beside her and began not with a traditional physical exam but with the simple question "What are you thinking about this morning?"

She began to tell me about how she was physically feeling- I interrupted her, "we'll get to that in a few minutes, tell me, 'What are you thinking about this morning'?"

"Why?", she replied.
"Because", I replied.
"Because why?", she replied. "Because I'm quiet and not smiling?"
"Maybe", said I.
"I don't feel myself this morning...I feel disorganized and out of sorts", said she.

And the doors opened.... "I don't feel like I'm in control like when I'm home. I miss my coffee and paper, I miss reading my Bible, I miss writing in my journal...I know God wouldn't give me more than I can handle, and I hate to whine..."
"Is this what you do every morning?", said I.
"Yes", said she.
"Hold those thoughts", said I.

I quickly found her assigned nurse and asked her to get our friend a cup of coffee and a newspaper and to see if she could find a Bible. While she did this I walked down to the Gift Shop and explained what I needed to the sales associate who told me she had the perfect journal and proceeded to take me over to a bin with various journals. She reached in, moved a couple around, then selected one and said "This is perfect". And she was right. For printed on the cover was the poem "Footprints". It was perfect.

As I paid for the journal, another associate, having heard my story, walked up to me with a nice ink pen and asked if she could buy it for my patient...how could I refuse.
When I went back up to the floor I handed the journal and pen to her nurse and told her after I have left the patient take the journal and pen in and tell her someone had overheard her story and had dropped off a gift.

I went back to check on my patient and she was sitting up, sipping coffee, reading her Bible and sweetly smiling...

"Does that help?", I asked.
"Very much", said she.
"Well I'm so glad, I'll come by later. I've asked the staff to see if they can find some paper and a pen so you can write later", said I.
"That's not necessary", said she.

I left.

Later in the day I returned to find her writing in her new journal with her new pen.

"Wow, that's some fancy paper and pen they found for you", said I.
"The nurses told me someone heard how I like to write in my journal and dropped this off for me, and look at the cover...it's perfect" said she.

"It is perfect", said I.

This would be a great story but it doesn't end here...for you see in her few days with us she had become friends with another patient and they would visit each other as they walked with physical therapists and staff.

Later on the night of the journal arrival, the other patient found out she was going to need emergency surgery and broke down in my patient's room. My patient listened to her fears and shared her own story, ending the conversation by sharing her journal entries and reading the "Footprints" poem from the front cover.

And does the story end there? We may never know....

Because...

"Each smallest act of kindness reverberates across great distances and spans of time, affecting lives unknown to the one whose generous spirit was the source of this good echo, because kindness is passed on and grows each time it's passed, until a simple courtesy becomes an act of selfless courage years later and far away." Dean Koontz

A friend asked me recently, "Why do you do it? Why do you respond to disasters?"

Great question! Often I have struggled to share how I feel about disaster relief and my role and what draws me back, time and time again.

The question has haunted me since returning from my first disaster response in September of 2005 to East Biloxia, Mississippi after Hurriane Katrina, and again after multiple responses to the Gulf Coast after it was ravaged by hurricanes, after my return from Haiti after the earthquake and again after working in the cholera treatment centers, and now after my latest deployment to the Pendleton County, Kentucky area this March following the devastating tornadoes in the area.

Others, of course, have tried to answer the question for me often using the words "crazy", "insane", "heroic", "an angel" and yet I don't feel any of those apply to "why do you do it?"

Other's just ask more questions hoping to help me define it:

"Is it the money?" Very few responses have been paid, some cover daily expenses, a few have provided financial compensation, but as my wife will tell you, by the time I replace the items (professional and personal) that I donate before I have left the disaster area I'm usually in the hole...

"Is it the adrenalin?" No that only lasts a few hours...then comes exhaustion...

"Is it the attention?" No, few ever know I was gone...except my family, close friends, an understanding boss, and my dog...

"Is it the collection of shirts, vests, jackets, uniforms, name tags?" Not really (but some of them are really cool!), and they do bring back great memories...

"Is it the chance to travel?" Have you ever slept on the ground or a mesquito net covered cot for two or three weeks eating MRE's three times a day...

"Is it 'a calling'?" I'm not sure, I've just always felt it was the right thing to do...

I do know that I have never felt it was about me. I have always felt it was about those whose daily lives have been touched by the disaster. With each response
I have cried with them, laughed with them, listened to them. I have heard their stories. And each and every time I leave to return home, I feel the people I was sent to care for have given me far more than I gave them. And yet I still struggle to answer the question.

Then last night a friend posted the following quote on Facebook:

"We lose ourselves in the things we love. We find ourselves there too." Kristin Martz

When I first received the invitation to speak at the Pinning Ceremony at my alma mater, I was not quite sure why they had chosen me. In fact I was pretty sure they had made a mistake. A quick email, a quick response, and I was assured they had the correct person. With that cleared up I of course accepted the offer.

I was honored. After all how hard could it be? All I had to do according to the email was "provide them with words of wisdom and encouragement as they complete nursing school and embark on their professional career in nursing".
Easy enough! I went straight to my computer to type out my words of wisdom and....

Nothing!

So I thought back to my first days in nursing school for "words of wisdom and encouragement to share" and remembered the following:

From the first day of class- "even as a student nurse, friends, family, and neighbors will always see you as a nurse"

From the Nightingale Pledge- "And will devote myself to the welfare of my patients, my family, and my community"

And most noteworthy, the unforgettable words of my preceptor- "Kevin, are you chewing gum?" and "Kevin, I would love to answer your question but I'm so distracted by the patient's dirty linen laying on the floor"

I also remembered being asked if I would have any interest in volunteering clinical time at a local homeless shelter where yet another preceptor shared "listen not only do what the patient is telling you but what they are not telling you".

Alright I thought, I'm on a roll...but suddenly my typing ceased and again....Nothing!

Seeking inspiration I turned to a dusty tote bin stored on a high shelf in my closet. Now, my wife Jackie will tell you I don't save many things but in that dusty tote are some seemingly insignificant items, however each is associated with its own "words of wisdom and encouragement to share".

The tote itself, a suggestion long ago from a mentor who said "store odds and ends from your RN career in there and when you begin to question why you are an RN, pull it down and remember...".

And in the tote:
The front page of the Dayton Daily News with my picture and an article about a local business man (me) who gave up his career to go to nursing school and on it the post-it-note from Dr Matre- "Kevin, I wrote a psych consult for you".

A rather generic looking white can with the famous Anheiser-Busch logo which much to my surprise (disappointment?) actually contained water. I received it on a Red Cross deployment to the West Washington floods and remembered the words- "things are not always what they appear".

Iron-on Red Cross nurse patches given to me by a retired RN during my first disaster deployment- "hope we haven't scared you away".

Post cards from a resident of Biloxi, Mississippi, given to me a week after Hurricane Katrina and her words-"I wanted you to know what our Biloxi looked like before Katrina and hope you'll come back when we've fixed it up".

Pictures of the devastation left behind by Katrina, thinking of my comment upon arrival at the Gulf "there is no beauty left here" and the words of a Buddhist monk- "look in the eyes of those around you, do you not see the beauty?".

A sun faded Salvation Army baseball cap and the kind Army staff who said- "we'll provide you with food and sleeping arrangements just take care of those who need you".

Cards and notes from patients and their families with the simple words "thank you".

Nursing related pins, patches, hats, and t-shirts from around the country which say- "you belong".

A coroner's business card reminding me of his words of advice when dealing with the families who have lost loved ones- "it never gets easier, and hope it never does".

A gear bag from "The Flying Pig Marathon" and the memory of an exhausted runner's words "thank you for helping me finish".

A picture of two small children we had dressed in surgical garb to surprise their grandpa who was scared and nervous before his surgery- "remembering not his words but the smile these little 'doctors' brought to him".

A letter from the father of two small children who despite our best efforts did not make it out of the trauma room and his words of kindness- "for caring so much and for all you did".

Brochures, magazines, and flyers from nursing presentations and speaking engagements, each with notes of encouragement from friend and mentor Dr Judy Church saying- "you can do it".

A pin from the Dayton Folk Festival and remembering the man on our Gator who as we rushed him to Grandview ER said "thank you, no one would help me".

A jeweler's business card from the store I purchased the engagement ring for the woman who said "go" when others said "don't" or "you must be crazy going there".

Thinking I had now enough "words of wisdom and encouragement", I stumbled upon an old Power Point presentation from days as a Diversity Class facilitator and found the following:

From the Bible (Mathew 25:35-40)
"I was sick and you looked after me"

"Whatever you did for one of the least of these brothers of mine, you did for me"

Genesis (104a)
"When the holy One loves a man, He sends him a present in the shape of a poor man, so that he should perform some good deed to him, through the merit of which he may draw a cord of grace."

From the Qur'an (76.8-9)
"They feed with food the needy wretch, the orphan, and the prisoner, for love of him, saying, 'we wish for no reward nor thanks from you'."

From the Tattvarthasutra (5.21)
"Rendering help to another is the function of human beings."

From the Tao (Tract of the Quiet Way)
"Relieve people in distress as speedily as you must release a fish from a dry rill (lest he die). Deliver people from danger as quickly as you must free a sparrow from a tight noose. Be compassionate to orphans and relieve widows. Respect the old and help the poor."

And finally I felt I had found enough to share...

So in the search for "words of wisdom and encouragement to share" with those students gathered together for their pinning as RNs, I rediscovered why I chose nursing. The tone was set with the Nightingale Pledge, carried over in clinical at St Vincent's Shelter, reinforced through days and weeks spent with those who experienced day to day as well as traumatic disasters both locally and nationally- caring for the simplest medical needs to complicated surgeries.

My wish for each of you is you go forth in nursing, infusing your nursing with your individuality, life skills, and experiences, and that you care for those in need whenever and wherever they may be, and that you care for each other as you would care for your patients.

May you find your passion in nursing, love what you do, never stop learning, never stop caring, and never stop listening.

So in these few moments we've shared, I hope each of you may have found, heard, or perhaps remembered your own "words of wisdom and encouragement".

And as for the title of this evening's presentation "from a single candle" I leave you with this...

"Thousands of candles can be lit from a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared." Buddha

On January 12, 2010 at 4:53pm EST a 7.0 magnitude earthquake struck the nation of Haiti destroying over 300,000 homes and buildings and taking the lives of over 200,000 people. As a nurse who has responded to many disasters within the United States, my heart cried out to assist the survivors. 48 hours later my OH5 DMAT was placed on alert for deployment to Haiti. When our orders came, I was faced with the reality we were going to a country few of us knew anything about; I knew we were facing challenges way beyond the experiences of past deployments.

In the early morning hours before we were to board our flight, doubt and fear set in and I questioned my decision to go.

It was in those dark hours I received a message from a friend who shared with me these words: "Then I heard the voice of the Lord saying, "Whom shall I send? And who will go for us?" And I said, "Here am I. Send me!" Isaiah 6:8. My doubts and fears subsided. The daunting task ahead seemed lighter. Darkness and fear was replaced with calmness and serenity. I knew I was where I needed to be. I boarded the plane to Haiti where I spent two weeks caring for the people of Haiti.

And here are the things I remember…

Haiti- “the Event”

Shambles, noise, dust...
Despair…
Hope…
Haunting eyes of the children…
Tragedy…
Life and Death…
An International Coalition of Care pouring their hearts and efforts into a country many had never paid attention to until “the Event”…
Long hours with the greatest of friends old and new…
MRE's...
Tears…
Smiles...
Cultural differences...
Life and death choices...
Failure to thrive...
Wondering if your efforts really make a difference...

I returned home and four days later I was again called again to serve. This time I did not question my decision- remembering instead “Here I am. Send me!”

Despair…
Hope…
Still the haunting eyes of the children...
A tent city on the other side of an iron fence and razor wire...
Tragedy as result of gunshot wounds, stabbings, rapes…
Again, Life and Death…
The generosity of a new portable x‐ray machine donated by J/P HRO…
Longer hours with new friends…
MRE's now picked over‐ will I ever be able to eat meatloaf again...
More tears…
More smiles...
Awakened late at night by a tremor…
Then again by casualties at the gate...
And finally, a cold night sweat rapidly followed by nausea and then vomiting…
Unable to keep anything down…
Exhaustion, muscle ache, cramping, and of course diarrhea…
Zofran, an IV, 7 pound weight loss…
And an early ticket home...

And would I do it again? Not soon, but yes I would go back....and only because of the wonderful loving and generous support of my wife and family who believe in me, the most amazing friends and neighbors who cared for my family, home and of course dog, co‐workers covering my absence, a most remarkable boss who supports me, and because it’s the least we can do for the people of Haiti....

In January and February of this year I worked in Haiti with United States NDMS DMAT and ImSurt teams providing medical and surgical care to the victims of the January 12th earthquake. What I experienced during those weeks only partially prepared me for what I would experience upon my return to Haiti on November 19th. My earlier experiences were in dealing with less critical and more chronic medical conditions. This time I would experience acutely ill patients requiring immediate life-saving treatment…

In October of this year, cholera erupted in the earthquake ravaged nation of Haiti. By the evening of my arrival in Port-au-Prince, the number of cases had grown to over 21,000 with 1250 deaths reported. This time I would be working with the J/P Haitian Relief Organization in response to an international call for medical personnel to combat this deadly outbreak.

Upon arrival at the J/P HRO housing that night, I received updates on the status of the cholera outbreak and learned I would be part of a medical team of J/P HRO medical volunteers, New Reality Medical volunteers, and Partners in Health healthcare providers and would possibly be heading the next morning to Hopital Ste. Therese in Hinche. Early the next morning J/P HRO co-founder Sean Penn received a call from Dr Paul Farmer of Partners in Health who stated “If you don’t send us any of your doctors and nurses you have available, people will die.”

With that simple statement, our team of seven (4 nurses, 2 translators, and our driver/security guard) were cleared to travel to Hinche, a three hour drive along often narrow and broken roads through the beautiful and rugged mountains and countryside.

We arrived in late afternoon, unloaded our gear and got an immediate orientation to the cholera treatment center (CTC) located on the grounds of Hopital St Therese. I believe we were all shocked by the world we entered. The CTC was fenced off to isolate the cholera patients and control access to the treatment area. Each point of access had an attendant who would spray the shoes of each person entering or exiting the CTC with a bleach solution in an attempt to minimize the carrying of any cholera bacteria into or out of the CTC.

The CTC facilities consisted of a triage and short term oral rehydration tent staffed by Cuban and Mexican physicians and nurses, and three additional tents (men’s, women’s, children’s) and an old church for those critical patients requiring IV rehydration with each facility holding up to 24 patients. Our medical team of four US RNs, two Canadian RNs, and one US physician along with a limited Haitian nursing staff, were responsible for these critical care patients.

The tents were old military heavy canvas, with USAID tarp floors constantly wet from the never ending mopping of human waste and with roots and old foundations underneath which presented constant trip hazards. The tents were dark and hot, even during the day when we would roll the sides up for some ventilation. Cots and cholera beds were crowded inside with very little space between them to provide care. We all became very adept at positioning ourselves to start or manage IVs. Even finding ways to hang the IV bottles became a skill as we had few IV poles and found creative ways to secure the IVs to the tent framework using pieces of rope often appropriated from parts of the tent support system. It was not uncommon to see chickens walk through the tents as well as the camp dogs wandering in and out. One of my most vivid memories of the tents is a member of our team, in what appeared to be a yoga position, starting an IV while a small dog sat in the tent entrance and a chicken pecked at the ground beside her.

The old church was dimly lit with little ventilation. It was downwind from the fire pit where medical waste, cholera patient’s clothing, and trash were constantly being burned. Late one evening, I witnessed an older Haitian woman perform a voodoo ceremony for a young patient in our care. In the morning I met the family, and though it was a bit unsettling, received a blessing from the same woman.

Working in the CTC at night provided additional challenges- less staff, poor lighting (both in and outside the tents and church), broken foundations, exposed tree roots, tent ropes and stakes, and a constant cacophony of noise- the cries from patients, sounds of dogs, goats, and chickens both in and outside the CTC, the sound of passing cars, trucks, motorcycles, U.N. vehicles, and occasional shouts from the gate for help from the families of arriving patients. And yet when you had the chance to look to the heavens you were struck by the beauty of the evening sky. One of my fondest memories was pointing out Orion’s Belt in the night sky to our Haitian security guard and him sharing the Haitian names for the stars in Orion’s Belt and how they were used for navigation.

We either never had, or ran low, on so many basic items- no NG tubes for inserting through the nose and into the stomach to get fluids into a patient, no IV extension tubing, few IV poles, not enough cots and cholera beds, and when gowns to cover patients ran low they were replaced with bits and pieces of clothing from our own suitcases and then with plastic garbage bags. When we ran out of patient cleaning materials, a bucket of bleach water and a mop were used to clean patients. Patients who were confused or demented and were pulling out their IV’s were often primitively restrained by the Haitian staff. We learned to work with extra large gloves and a limited choice of IV needle sizes. We learned to place IO IVs using a simple 16 gauge needle, and place external jugular IV’s when we could not find a peripheral vein. We turned our headlamps off when not performing critical tasks so we could conserve batteries. When certain supplies ran low we made difficult decisions on how they would be allocated. And when a patient died and we had no body bags to place them in- our transporters simply wrapped them in whatever they could find and carried them over to a space near the fire pit to hopefully be claimed in the morning. Every night at some point the generators would stop and we would be immersed in total darkness lit only by the headlamps of our team. After one such blackout we went into the men’s tent only to find a patient missing- no one seemed to know where he had gone- after an exhaustive search his lifeless body was found by the fire pit. We were never able to get a clear story regarding who declared him dead or moved him. And when our US physician left and we were without a doctor we remembered his words- “Do what you can, you are all they have.”

Over the course of five days, a thousand patients, tears, laughter, life and death- we became a close team, forged by experiences and enduring conditions we could not have imagined upon our arrival in Haiti. We became friends, colleagues, teachers, mentors, and “shoulders to lean on”. We found strength in each other during even the darkest moments. One of our team members shared a great way to deal with the darkness advising each of us to find “a face to remember”- the face of one patient for who you know you made a difference. For me it was a young child named “Evans” who when I first carried him from triage to the children’s tent was unresponsive, severely dehydrated, and had only a femoral pulse. Three of us worked on Evans for over three hours to find IV access, finally succeeding in placing two IO needles in his legs so we could get the vital fluids his body so desperately needed running. For the rest of the night Evans showed little improvement. Early in the morning we again attempted to find a peripheral vein for an IV and as we attempted to stick the IV in his arm he suddenly tried to bite our interpreter who was holding him down. Three hours later Evans was sitting up and as I left that morning gave me a fist bump and the most beautiful smile!

Even now as time and miles separate us and our memories begin to blur and our stories begin to fade- we will remember this:

Together we saved lives, we made a difference…

To our friends at J/P HRO- you brought us together…

To the Haitian staff at Hopital Ste. Therese- you are an amazing, dedicated group of people!

And to our family and friends- Thank you for your love, compassion, faith, and support which allows us to do what we do.]